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General NPI Number Information
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NPI Number | 1396463832
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Entity Type | Individual
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Provider Name | GABRIELLE PLUYM
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 1520 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60622-1967
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Country | US
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Telephone | 312-283-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 159 BERMUDA DR
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City | MANKATO
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State | MN
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Zip | 56001-4122
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Country | US
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Telephone | 507-720-2531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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